My work is all about improving health and health care through knowledge. It spans medical publishing to community health, taking in technology and innovation, and is influenced by growing up in a working-class community. I share insights from all of the above through public speaking.

Oct 18 Bravery, agility and uncertainty

I’ve spent much of this week thinking about what it takes to get a new idea off the ground. As you know, Wellthcare is so new the paint is not dry; indeed, I’m pretty sure we’re still choosing the colour. This is a problem because a big part of what it takes to get a new idea off the ground is money but people with money want to know exactly what they’re getting in to. At first glance, this makes sense but when you look at the world around us I believe it makes no sense at all.

Health care is in crisis. Folks with longer memories than me tell me that it’s always been in crisis but I’m not sure that means we can accept it as the status quo. We need radical new ideas but to get to them we need to first see the problems for what they are, not what we’re told they are.

Academia often tells us what to think. Those clever people with their salaries and their pensions are filling the pages of some 24,000 biomedical journals across the world with hypotheses, proof, refutations and debate. I was an academic publisher for almost a decade and I know this world well. It’s vital, necessary, important, crucial – but all too often it’s filled with navel-gazing and unwarranted procrastination.

Don’t get me wrong. I’m a great believer in “evidence-based medicine” but most people – especially those that use the term a lot – have no clue of what it really means (and doesn’t mean). What I have always loved about the term is the fine balance it places between what we can learn from reductionist research practices (such as randomised, controlled trials) and direct experience of the real world. Too many academics focus on the former, conveniently ignoring the more complex and nuanced latter.

I awoke this morning to an email from Maneesh Juneja, one of the Wellthcare Explorers, with the subject line: “Horrible headline today”. The email consisted of a photograph of the front page of The Daily Telegraph with an article about “Britain’s forgotten million old people”. All his email said was: “Even more need for Wellthcare”.

He’s right. Wellthcare is about finding new, health-related value in our nano-networks. As I have been clear from the beginning, we don’t yet have the answers. Sure, there is research-derived theory on this – from anthropology, social capital, urban planning, network analysis, behavioural economics – but we don’t really know what works in the real world and what’s likely to keep working.

We need the bravery to do real-world experiments. We need the bravery to learn on the fly. We need the bravery to accept nuance and complexity. What we can’t have is knowledge of exactly what we’re getting in to.

I spend much of my time talking to people about Wellthcare. I have grown to love their confused expressions when I talk about it being a “re-imaging of the role of health care in society” or “an attempt to start a different conversation about health”. We’ve become too accustomed to the current, reductionist shape of the world – an artifice based on old thinking. We’ve stopped seeing things for what they are. We’ve stopped noticing that our tools no longer work.

What makes me deeply sad, though, is when people tell me Wellthcare is too big an idea for the UK or Europe, and that I need to go to the US “because that’s where they think big”. It saddens me to my core that we openly admit that we’ve stopped thinking, we’ve stopped wanting to take risks, that we need others to lead the way.

Again, don’t get me wrong. I have a deep love for the US and, to be honest, when British conservatism wears me down I often schedule a trip out there to get an injection of enthusiasm. But is it really the case that we’re too afraid to think in Europe? Are our class-based societies so divided such that the haves needn’t worry about the have-nots? And if so, is there really enough sand in the world for all of Europe’s “leaders” to stick their heads into?

What it takes to get a new idea off the ground is for people to be brave enough to see that there is a problem. The flipside of that problem is a significant opportunity but the world has become a difficult place to predict. Telling people exactly what we’re getting into is a fool’s game. The future is about uncertainty, trial-and-error. It’s not so much about thinking “big” as it is about thinking agile, learning and staying the course. Is Europe really throwing in the towel?